The changing face of hospitalisation due to gastrointestinal bleeding and perforation

Lanas, Ángel; Garcı́a-Rodrı́guez, Luis Alberto; Polo-Tomás, Mónica; Ponce, Marta; Quintero, Enrique; Pérez-Aisa, Maria Ángeles; Gisbert, Javier P.; Bujanda, Luís; Castro, Manuel; Muñoz, M.; Del-Pino, Muriel; García, Santiago López

doi:10.1111/j.1365-2036.2010.04563.x

Cited by 141 publications

(93 citation statements)

References 21 publications

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“…However, the clinical presentation can be misleading, as the cathartic and pro-peristaltic properties of intraluminal blood may cause hematochezia in a patient who is bleeding massively from the upper tract [8][9][10]. While upper GI bleeding is more common than lower GI bleeding [1,5,7], there has been a gradual trend in the opposite direction over the past 10 years, which may be related to the decrease in the prevalence of peptic ulcer disease and a growth of the elderly population [11,12]. The severity or rate of GI bleeding can be categorized as massive, moderate, or minor depending upon the hemodynamic status of the patient [5].…”

Section: Epidemiology and Clinical Presentation Of Gastrointestinal Bmentioning

confidence: 98%

Gastrointestinal hemorrhage: evaluation with MDCT

2015

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Gastrointestinal (GI) bleeding is a common medical problem, with high associated morbidity and mortality. The clinical presentation of gastrointestinal hemorrhage varies with the location of the bleeding source, the intensity of the bleed, and the presence of comorbidities that affect the ability to tolerate blood loss. Conventional endoscopic examinations are usually the initial diagnostic tests in patients presenting with overt gastrointestinal hemorrhage. However, implementation of upper tract endoscopy and colonoscopy in the emergency setting can be challenging due to inconsistent availability of the service and difficulties in achieving adequate colonic cleansing in emergent situations. Thus, imaging tests are often relied upon to establish the location and the cause of bleeding, either for initial diagnosis or after non-revealing upper and lower tract endoscopies ("obscure" bleeding). This article discusses the imaging evaluation of patients with gastrointestinal bleeding and reviews the imaging appearance of the most common causes, taking into account the two most relevant clinical presentations: overt bleeding and obscure bleeding.

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Section: Epidemiology and Clinical Presentation Of Gastrointestinal Bmentioning

confidence: 98%

Gastrointestinal hemorrhage: evaluation with MDCT

2015

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“…36,40,41 Although UGIB and peptic ulcer bleeding are decreasing in the general population overall, rates of hospitalization because of ulcer complications are increasing in elderly populations. 42 This paradoxic observation is thought to be caused by longer life expectancy in Western countries leading to increased occurrences of cardiovascular and rheumatic diseases that are associated with an increased use of aspirin and NSAIDs among the elderly population. 43 Studies from other parts of the world also show this trend in decreasing PUD.…”

Section: Worldwide/regional Incidencementioning

confidence: 99%

“…35 Although not well defined, decreases in H pylori and prevention strategies with NSAIDs have led to decreases in the incidence of UGIB. 42 However, decreases in mortality are more likely caused by advances in medical management with PPIs combined with more effective endoscopic therapies and shorter time to endoscopy. Supporting this premise are data indicating that, in the United States, rates of endoscopy, early endoscopy, and endoscopic therapy have increased substantially over the past 20 years.…”

Section: Worldwide/regional Incidencementioning

confidence: 99%

Epidemiology and Risk Factors for Upper Gastrointestinal Bleeding

Tielleman

Bujanda

Cryer³

2015

Gastrointestinal Endoscopy Clinics of North America

127

101

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“…The aspect that has best been studied is the bleeding risk, which is markedly increased for NSAIDs and aspirin [34,35], even at a daily dose of 100 mg [35]. Individual articles show an increased bleeding risk for acetaminophen, corticosteroids and calcium antagonists (table 6).…”

Section: Influencing Factorsmentioning

confidence: 99%

Diverticular Disease: Guidelines of the German Society for Gastroenterology, Digestive and Metabolic Diseases and the German Society for General and Visceral Surgery

Kruis

Germer²,

Leifeld³

et al. 2014

Digestion

134

117

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Background: Diverticular disease is one of the most common disorders of the gastrointestinal tract. 28-45% of the population develop colonic diverticula, while about 25% suffer symptoms and about 5% complications. Aim: To create formal guidelines for diagnosis and management. Methods: Six working groups with 44 participants analyzed key questions in subject areas assigned to them. Following a systematic literature search, 451 publications were included. Consensus was obtained by agreement within the working groups, two Delphi processes and a guideline conference. Results: Targeted management of diverticular disease requires a classificatory diagnosis. A new classification was created. In addition to the clinical examination, intestinal ultrasound or computed tomography is the determining factor. Interval colonoscopy is recommended to exclude comorbidities. A low-fiber diet, obesity, lack of exercise, smoking and immunosuppression have an adverse impact on diverticulosis. This can lead to diverticulitis. Antibiotics are no longer recommended in uncomplicated diverticulitis if no risk factors such as immunosuppression are present. If close monitoring is ensured, uncomplicated diverticulitis can be treated on an outpatient basis. Complicated diverticulitis should be treated in hospital, involving broad-spectrum antibiotic therapy, where necessary abscess drainage, and surgery, if possible laparoscopically. In the case of chronic relapsing diverticulitis, the risk of perforation decreases with each episode, so that surgery is no longer recommended after the second episode but only following individual assessment. Conclusions: New findings on diverticular disease call into question the overuse of antibiotics and excessive indications for surgery. Targeted treatment requires a precise diagnosis and intensive interdisciplinary cooperation. i 2014 S. Karger AG, Basel

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The changing face of hospitalisation due to gastrointestinal bleeding and perforation

Abstract: SUMMARY BackgroundTemporal changes in the incidence of cause-specific gastrointestinal (GI) complications may be one of the factors underlying changing medical practice patterns.

Cited by 141 publications

References 21 publications

Gastrointestinal hemorrhage: evaluation with MDCT

Gastrointestinal hemorrhage: evaluation with MDCT

Epidemiology and Risk Factors for Upper Gastrointestinal Bleeding

Diverticular Disease: Guidelines of the German Society for Gastroenterology, Digestive and Metabolic Diseases and the German Society for General and Visceral Surgery

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